What is rhinoplasty surgery?

Rhinoplasty surgery, commonly known as a nose job, is an operation to reshape the nose. It is one of the most common plastic surgeries.

Rhinoplasty can:

• increase or reduce the size of the nose;
• change the shape of the tip of the nose, the bridge of the nose and the nostrils;
• change the angle between the nose and the upper lip; and
• straighten the septum (the part inside the nose that separates the nostrils) with a procedure called septoplasty.

There are limits to how much a nose can be altered. The final result will depend on the size of your nose, the condition of your skin and your age. The most important thing is that you communicate clearly with your surgeon about what you want and what is possible.You should bear in mind that surgery alone would not solve any emotional or social problems you may think are caused by your nose or your appearance in general.

Why have rhinoplasty surgery?

Many people are self-conscious about the shape of their nose and have rhinoplasty for cosmetic reasons (that is, to improve the appearance of their nose).If this is the case, the aim of the operation would be to make your nose look right for you and to make you less self-conscious about it. So it is very important that you are clear in your mind what you dislike about your nose, and that you can explain this to your surgeon. He or she will then be able to tell you what is surgically possible and what is not.Most people who dislike their nose have concerns about the bridge or the tip.

• Rhinoplasty is most commonly carried out to:
• alter the hump at the bridge of the nose;
• reshape the tip of the nose;
• change the length or width of the nose;
• change the width of the nostrils.

Other patients may choose to have rhinoplasty because of an injury to the nose, if the nose has been broken or bent by some kind of accident. Others may have breathing problems relating to the nasal airways, and will choose to have septoplasty.
In both of these cases, rhinoplasty would be considered to be reconstructive, whereas for the majority of nose operations the surgery is classed as cosmetic. Septoplasty can sometimes be carried out at the same time as the work to improve the appearance of the nose.

What will happen before my operation?

You will meet your surgeon to talk about why you want surgery and what you want. The surgeon will make a note of any illnesses you have or have had in the past. They will also make a record of any medication you are on, including herbal remedies and medicines that are not prescribed by your doctor.
Your surgeon will examine your nose, and may take some photographs for your medical records. They will ask you to sign a consent form for taking, storing and using the photographs. You may also be asked to talk to other members of the team, such as a psychologist.
The surgeon will measure your height and weight to make sure that it is safe to do an operation. If you are overweight, or planning to become pregnant, your surgeon may suggest delaying your operation.

How is the surgery performed?

Rhinoplasty to change the shape of the nose is performed either from inside the nostrils (called closed rhinoplasty) or by making a small cut between the nostrils and lifting the skin, as shown opposite (this is called open rhinoplasty). The precise nature of the operation will depend on the area of the nose that is being treated. The scar may be straight, V-shaped or zigzag.

Changing the ridge of the nose

If the bridge of the nose is being operated on, the surgeon removes the bone and cartilage that is causing the ‘hump’. The nose may then be broken so the remaining pieces of bone can be moved closer together to narrow the nose.

Changing the tip of the nose

If the tip of the nose is being operated on, the cartilage that makes up the support under the tip needs to be partly removed or reshaped. This can be done through closed or open rhinoplasty.

Changing the length of the nose

Your surgeon will adjust and reduce the septum, to help shrink the tip and reduce the overall length of the nose. Adjusting the cartilage at the tip of the nose can also reduce the length of the nose.

Changing the width of the nose

Your surgeon can reduce the width of the nose, to make it narrower, by breaking the bone and repositioning it.

Increasing the bridge or tip of the nose

Surgeons can use bone or cartilage, or an implant, to change the contour of a ‘flat’ bridge or tip. This is called additional rhinoplasty or augmentation rhinoplasty. The bone or cartilage used can be taken from the nose (the nasal bone or the septum), or from other places such as the rib, hip or ear

Changing the septum

If your nose has been flattened by an injury, the septum could be buckled, making breathing difficult. This can sometimes be altered at the same time as the surgery explained on the previous page, or as a separate operation.

Choosing a surgeon

If you decide to have rhinoplasty, only go to a surgeon who is properly trained and on the specialist register held by the General Medical Council. They will talk to you about what is possible for you or might give the best results. Members of several different organisations do cosmetic surgery, so your general practitioner (GP) is the best person to advise you on who to see. You should talk to your surgeon before your operation about when and how to pay. Nobody needs urgent rhinoplasty. If you are not given time to think about it, you should look elsewhere.

How can I help my operation be a success?

Be as healthy as possible. It is important to keep your weight steady with a good diet and regular exercise. Your GP can give you advice on this.
If you smoke, stopping at least six weeks before the operation will help to reduce the risk of complications.
Do not worry about removing hair near where cuts will be made, but do wash your face during the 24 hours before your operation to make sure that the area is as clean as possible.

What is the alternative treatment?

There is no surgical alternative to rhinoplasty. Sometimes, just surgery on the inside of the nose is needed to solve problems with the airways in the nose. Non-surgical options such as fillers can be used as a temporary treatment for cosmetic purposes.

What are the main risks and complications of rhinoplasty?

As with all operations, there are risks involved in having rhinoplasty. Although the risks are unlikely, it is important to weigh them up against the potential benefit of the surgery. Discuss each of them with your plastic surgeon to make sure you understand the potential complications and consequences.

Complications associated with the surgery

• Scars There will be scars from the surgery. These will usually be red at first, then purple, and then fade to become paler over 12 to 18 months. Occasionally, scars may become wider, thicker, red or painful, and you may need to have surgery to correct them.If bone, cartilage or skin has been taken from another part of the body, this will leave a scar which may be noticeable.
• Bleeding Heavy bleeding is unusual but possible, and you may need another operation to stop the bleeding, which can delay healing or affect the result. Any bleeding usually happens immediately after, or soon after, surgery. Before the surgery your surgeon will discuss any medicines that increase your risk of bleeding, and it is important to control high blood pressure.
• Infection If you get an infection of the wound you may need antibiotics or another operation. This can affect the final result of the surgery. It is important that you do not have a cough, cold or sore throat at the time of your operation. If you have any doubts, you should contact your surgeon.
• Swelling, bruising and pain After the operation, there will be some swelling and bruising of the face, particularly around the eyes. This can take time to settle. Once the swelling has settled, you will find that your nose feels stiff and numb. The numbness usually disappears over the next few months, but the stiffness may be permanent. There may be long-term pain, but this is uncommon. The final result may not be achieved for 12 to 18 months after the surgery.
• Healing problems Sometimes, wounds can take longer than normal to heal. Usually, this problem is solved by dressing the wounds, but you may need further surgery to remove the tissue that has not healed properly. Smokers are more likely to have healing problems.
• Extrusion This is where deep stitches poke out through the skin. These can easily be removed. If an implant or piece of bone or cartilage has been used, in rare cases this can poke out through the skin months or years later, particularly after an injury.
• Increased or reduced sensation After the surgery, most patients will get some alteration in the sensation on their nose, most commonly numbness of the nose or of the top lip or teeth. Loss of sensation, though rare, may be permanent.
• Asymmetry This is where the nose is not symmetrical.
• Damage to deeper structures Although rare, the surgery can damage deeper structures, including nerves, blood vessels, tear ducts and the lining of the skull. This damage may be temporary or permanent.
• Hole in the septum (septal perforation) In rare cases, a hole develops in the septum, either during the surgery or as a result of a collection of blood. If this happens, you may need another operation to repair the hole. Sometimes it is impossible to repair the hole.
• Breathing difficulties During the first week after the operation it is quite common to have some difficulty breathing through the nose. This problem usually disappears as the swelling goes down, but it can be permanent.
• Altered sense of smell After rhinoplasty, some patients’ sense of smell (and sometimes their sense of taste) changes. This change can be permanent.
• Unsatisfactory result Sometimes, patients are not satisfied with the result of their rhinoplasty. This may be to do with the look or feel of the nose, or the shape of it not meeting expectations. It is very important that you talk to your surgeon, before you have the surgery, about the size and shape you want, and whether this can be safely achieved with a good outcome.
• Change over time The appearance of your nose will change as a result of ageing, sun exposure or other circumstances not related to your surgery. You may need further surgery or other treatments to maintain the results of the rhinoplasty.
• Allergic reaction Rarely, allergic reactions to tape, stitches or solutions have been reported. If you have an allergic reaction you may need extra treatment.

Risks of anaesthetic

• Allergic reactions You could have an allergic reaction to the anaesthetic.
• Chest infection There is a small risk of chest infection. The risk is higher if you smoke.
• Blood clots Blood clots can form in the leg (called a deep vein thrombosis or ‘DVT’). These cause pain and swelling and need to be treated with blood-thinning medication. In rare cases, part of the clot breaks off and goes to the lungs (called a pulmonary embolus or ‘PE’). The risk of this is higher if you smoke, are overweight or are taking the contraceptive pill.
• Heart attack or stroke A heart attack or stroke could be caused by the strain surgery places on your heart. You will be assessed for the risk of this before your surgery.
• Death As with all surgery, it is possible to die as a result of the operation.

What to expect after the operation

Rhinoplasty surgery is usually carried out under a general anaesthetic (so you would be asleep). The operation usually takes about two hours. You might be given antibiotics to keep the wound clean. You might go home the same day, or stay in hospital overnight. If you do go home on the same day, a responsible adult should stay with you for the night.
Your nose will feel tight and sore. Simple painkillers should be enough to keep you comfortable. If your nose was broken as part of the surgery, there will be noticeable bruising around the eyes for about seven to10 days, with yellowing around the eyes for 10 to 20 days.

Dressings

You will have some dressings in each nostril, and may have a pad under your nose. You might also have a splint over your nose to protect it. Once the splint has been removed, you must be very careful to avoid knocking your nose, as this may affect the final result.

Stitches

Stitches inside your nose will probably dissolve on their own. You may have stitches on the outside of your nose. These would have to be removed, usually after five to seven days after the surgery.

Recovery

You may have a little bleeding from your nose for the first day or two after your operation. Dab this away gently with gauze or a clean handkerchief. Avoid any activities where you might knock your nose. Activities that increase the blood flow in your face (such as bending down, straining, lifting or having a hot bath) may increase the chance of bleeding.Sleeping with extra pillows to keep your head propped up will help reduce swelling and keep you lying on your back.
Do not blow your nose, and try your best not to sneeze through your nose. If you are going to sneeze, cough it out. Once the dressings have been removed from your nostrils, you can clear your nose by sniffing into the back of your throat. Unless you are told otherwise, it is better to leave any crusts in your nostrils until you have your post-operative review.
You will be out of bed on the same day as your surgery, and doing light activities after two weeks. You should be able to swim after four weeks, although you should avoid strenuous exercise for six weeks. Most patients take at least two weeks off work after the operation, depending on their job. Do not lift heavy things for several weeks, and avoid sex for at least two weeks. With all activities, start gently.
Do not drive until you feel safe. Check your insurance documents if you are not sure.

Seeing the results

It can take several months for the swelling to settle, and many months for the final result to appear. Most patients are pleased with the final result, but some find their new nose difficult to get used to. This may happen to you.

Your aftercare

• To protect your nose, and get the best result, look after yourself.
• Avoid vigorous activities after your operation.
• Protect your wounds as you are told to.
• Putting on weight or being pregnant will affect the results.
• Maintain a healthy weight and level of exercise.

What to look out for

Bleeding after surgery can cause swelling, a change in colour, and pain. The signs of an infection are pain, redness, swelling and pus in the wound, and you may also have a temperature. A blood clot in the leg can cause swelling and pain in the calf. If the clot goes to the lung, you might be breathless or have pain in your chest. If the wound is not healing well, it may be sore and weep.
If you have any worries after your operation, speak to a doctor or go to A&E.

Disclaimer
This document is designed to give you useful information. It is not advice on your specific needs and circumstances. It does not replace the need for you to have a thorough consultation, so you should get advice from a suitably qualified medical practitioner. We – The BAAPS and BAPRAS – have no liability for any decision you make about the surgery you decide to have.